Understanding the quest for the “perfect body”: The links between perfectionism, body dissatisfaction, and EDs

Body dissatisfaction and body dysmorphia are some of the most frequently discussed symptoms of EDs. In his work on the “transdiagnostic model” of EDs, Christopher Fairburn asserts that these two features not only unite all of the different ED diagnoses but also are at the heart cause of the disorder. Although I don’t agree with everything about this assertion, body image issues affect many with eating disorders and can cause much suffering.

Most of the research on body image and EDs has focused on media inputs: the digitally altered models, the completely unrealistic beauty standards for both men and women. I won’t argue with anyone who asserts that these are very real and very harmful and no doubt contribute to our culture’s completely messed up attitudes towards food and weight. While media is definitely a factor, it doesn’t explain why some people get so hung up on body image and others really don’t. One possible answer is perfectionism. A study published last month in the new open access Journal of Eating Disorders by Tracey Wade and Marika Tiggemann found that self-oriented perfection was a strong predictor of body dissatisfaction.

More on perfectionism

First, a little background on perfectionism. Researchers generally define perfectionism as “those who strain compulsively and unceasingly toward unobtainable goals, and who measure their self-worth with their productivity and accomplishment. Pressuring oneself to achieve such unrealistic goals inevitably sets the individual up for disappointment. Perfectionists tend to be harsh critics of themselves when they do not meet the standards they set for themselves.”

I’m kind of surprised that a picture of me did not accompany this definition.

There are several types of perfectionism, depending on who you ask. In this study, the researchers used two of the most common constructs of perfectionism. The first construct (Hewitt & Flett, 1991) looks at the intra- and interpersonal types of perfectionism and divides it into three categories: self-oriented perfectionism (“setting high [personal] standards for achievement and self-criticism for not meeting standards”), others-oriented perfectionism (“having high standards for other people that are unrealistic”), and socially-prescribed perfectionism (“perceiving that other people hold unrealistically high standards for the individual”). In research studies on EDs, scientists have found that perfectionism in general is a risk factor for EDs, and that self-oriented perfectionism is the strongest risk factor (Bardone-Cone et al., 2007).

The second construct the researchers used to evaluate perfectionism is the Frost Multi-Dimensional Perfectionism Scale (Frost et al., 1990), which evaluates the following 6 factors: “Personal Standards (setting high standards), Concern over Mistakes (negative reactions to mistakes and perceiving mistakes as failures), Doubts about Actions (doubting one’s own performance), Parental Expectations (parents setting high standards), Parental Criticism (parents criticising for mistakes), and Organisation (organisation and neatness).” As a side note, I’m curious how one’s own perfectionism might influence the effects of parental expectations and criticism (ie, perceiving higher expectations and levels of criticism than were actually there or intended). That being said, perfectionism has fairly strong genetic components, so it wouldn’t be unexpected for a perfectionistic kid to have perfectionistic parents (I did.)

{{The quotes in the above two paragraphs were taken from the Wade and Tiggemann study.}}

When researchers measured perfectionism in adolescents with the Frost MDPS and compared this to eating disorder symptoms, they found that the highest risks were found in the teens with BOTH high personal standards and high evaluative concerns (concern over mistakes, doubts about actions, parental expectations, and parental criticism) (Boone et al., 2010). In summary, both constructs of perfection appear to be elevated in people with EDs or ED symptoms, making these good choices to measure the relationship between perfectionism and body dissatisfaction.

What they found

The researchers surveyed 1083 women as part of the Australian Twin Registry, assessing them both by telephone interview (gathering basic demographics and administering the Eating Disorders Examination) and by a self-report questionnaire (the Frost MDPS). The women were also asked to select their current body shape from a series of silhouettes (below), as well as their ideal body shape. They were also asked about their desired and current BMI.

Body silhouettes, as seen in Bhuiyan et al., 2003, adapted from Stunkard, Sorenson, and Schlusinger.

The researchers found that the higher your level of perfectionism, the higher the discrepancy between your current body shape and your ideal body shape. As well, higher perfectionism was also independently associated with wanting a thinner body, regardless of your current body weight. In particular, the researchers identified three aspects of perfectionism that were particularly associated with body dissatisfaction: concern over mistakes, organization, and doubt about action. The strength of the associations were in that order, from strongest to weakest. The researchers concluded:

In terms of how perfectionism exerts an effect on body dissatisfaction, it may be that the highest levels of body dissatisfaction which can act as risk factors for the later development of disordered eating are associated with high levels of both organisation and a concern over mistakes that results in criticism of oneself as a person. To the degree that organisation indicates a need to exert control over the environment, those people high on organisational traits may display more extreme efforts to control body appearance. Any resultant failure to meet the desired standards in this domain results in self-criticism and negative affect which is suggested to be part of the vicious cycle that perpetuates unhelpful perfectionism.

It’s important to note that these were not subjects with eating disorders. They were normal, everyday women, so exactly how perfectionism and body dissatisfaction interact in clinical eating disorders may be slightly different. For another, these women were around 35 years old, so how these results apply to younger and older women, as well as men, remains to be seen.

The researchers note that focusing on perfectionism in ED prevention may be useful. I think this would be extremely beneficial, especially when compared to current ED prevention efforts.

25 Responses to “Understanding the quest for the “perfect body”: The links between perfectionism, body dissatisfaction, and EDs”

I get the perfectionist link. I’m not sure that digitally altered media is a motivator- at least not for me- it is more of an enabler. For the person who cannot see their own thinness, to hear others say they are too thin, and then to see pictures of people who are obviously very thin- it makes the person think, What’s everyone so upset about w/me? Here’s a whole magazine full of happy people, all obviously smaller than me, and they’re all ok. Obviously, I am ok. And my treatment team is nuts. Or just being dramatic.

But back to the perfectionist thing- I think not only does perfectionism motivate the ed from the inside- that is, I’m not eating healthy enough, or I’m eating too much, etc- but also from the outside- that is, I have to get this paper/essay/project/whatever JUST RIGHT and that is my only focus so I forget to eat. Or I can’t eat (or sleep, or pee, or stretch) until I’m done with this [whatever], b/c getting this JUST RIGHT is ALL that matters right now. And that means, food keeps getting put off and put off and the brain and the stomach adjust accordingly, pushing a person further towards malnutrition, exhaustion, and ed-ville.

Then there is the hell within recovery, during which the treatment team’s expectations finally begin to take root within your psyche but the ed’s expectations are still also very much present, and you are constantly sick with failure over never meeting either set of expectations just right. Failure on every side. Nowhere to rest from it. But if the treatment team backs off of their expectations even a little, to ease the feelings of failure, then the ed is THRILLED to jump back in front and center and make ITS expectations once more the priority…

Yes, addressing/easing perfectionism in treatment would be grand. But how the hell to do that?

I don’t really care about models etc in the media, because the perfectionism is about me. If somebody else is tired, or cranky, or hungry, then that’s fine. But I’m constantly judging myself by my own standards. I can’t apply them to anyone else, because then it’s obvious they’re impossible ideals. Somehow, the rules are different when they apply to me

Right. I’m the same way. I don’t judge others for being hungry, tired, or gaining weight, but I totally hate myself when that happens. I’m much better at it now, but I’m still so much harder on myself than I ever would be on anyone else.

My psychiatrist kept trying to talk me through the difference between perfectionism and mastery. Perfectionism says that a baby should be able to stand up and run perfectly; mastery says that there will be wobbles and stumbles, but that the baby learns from each one, and keeps learning. I like the theory – but again, I have difficulty applying it to me!

According to this definition of perfectionism, I am not a perfectionist because my goals are obtainable. Yet, my efforts to obtain perfection impair my functioning to the degree that it is sometimes disabling.

This isn’t the technical definition of perfectionism, just a quote from Wikipedia. Since you state it’s disabling, then it would meet criteria, in my book anyway.

Forgive me if I’m really dense, but I’m not sure I understand the bit about your goals being attainable but you were still trying to achieve perfection. Could you explain? If you’d rather not on here, that’s fine. I just don’t quite follow.

The distinction between self- and others-oriented perfectionism makes a lot of sense to me, since I am as forgiving of other people as I am incredibly hard on myself. My mom used to ask me (when I was beating myself up for getting a 97 on a test, or what have you), “If you think you’re a failure, then where does that leave the rest of us?” The question would totally perplex me because I honestly, truly did not think that way. Everyone else was better than I was, obviously! It didn’t matter that their grades were objectively lower.

I have a question related to your last paragraph. Do you think that perfectionism causes EDs, or just that it tends to be associated with them? I mean, it’s undeniable that my natural perfectionism is now “recruited” to sustain my food, weight, and body concerns . . . but it’s equally undeniable that I spent 15 years pre-illness being perfectionistic without showing any signs of an eating disorder. So it seems to me that anorexia is not the same as extreme perfectionism, even if it does make use of the perfectionistic traits a sufferer may happen to have. But can reducing perfectionism really be expected to prevent EDs? My eating disorder is such an ingrained, seemingly intractable (and certainly involuntary) part of my thinking that it’s hard for me to imagine it stems from some aspect of my personality I could have been trained to suppress.

I’m like you. I wish I could be free of my distorted body image and thinking but I can’t even imagine life without it. The things I could have done, the freedom I may have felt. If only I’d been able to shake it. Instead I hid it and hid it and when I eventually got brave enough after 15 years of suffering and confessed to having an ED to my mother- she didn’t even care. She said “oh yeah I think I saw something about that on Oprah once. Do you want to go to Costco I need some things.” And that was the end of that. Is it any wonder I never got better but only worse? Humans need love.

Excellent research! I recommend a book by famed psychiatrist Alice Miller called ” The Body Never Lies” about childhood trauma and lack of emotional relationship with mothers leading to many health issues in us including the perfectionism and eating disorders.

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[…] to many eating disorders (read more about what perfectionism is and how it relates to body image here). Many patients report high levels of perfectionism both before and during the disorder, which has […]

[…] to many eating disorders (read more about what perfectionism is and how it relates to body image here). Many patients report high levels of perfectionism both before and during the disorder, which has […]

[…] a role in the causation of EDs in the general population. Certainly it’s a factor, especially in perfectionists. I would disagree that the media actually causes EDs, but as a significant environmental factor, we […]